INSURED INFORMATION

Name of Insured: _______________________________________________________________________________________________

All Retail questions included on this questionnaire are class specific. Please see information below that will be needed for quoting retail clients.

For Delicatessens:

1. Do the Insured’s liquor receipts exceed 35% of their total receipts? Yes No

2. Does the Insured offer check cashing for customers? Yes No

3. Is there a restaurant/cooking exposure? Yes No

a. If So, is there deep fat frying? Yes No

b. Is the cooking equipment UL 300 approved? Yes No

For Furniture and Fixture Stores:

1. Does the Insured provide any installation or delivery services? Yes No

2. Does the Insured sell items on consignment? Yes No

a. If Yes, what percentage of sales is generated from consignment? _______%

b. Are there written contracts in place with consignment customers? Yes No

3. Does the Insured sell the following:

a. Oriental/Persian Rugs Yes No

b. Antiques Yes No

For Auto Parts & Accessories Stores:

1. Does the Insured sell any used, rebuilt or refurbished parts? Yes No

For Cosmetic, Beauty Supply & Perfume stores, Candy Stores, or Beverage Stores:

1. Does the Insured distribute or sell nutritional or body-enhancing supplements, energy drinks

or any other nutraceuticals? Yes No

For Hardware Stores:

1. Does the Insured sell any of the following products:

a. Firearms/Ammunition Yes No

b. LPG Tanks/Fill LPG Tanks Yes No

2. Does the Insured rent any equipment to others? Yes No

a. If Yes, please explain. _________________________________________________________________________________

3. Are there any lumber sales? Yes No

P O I N T O F S A L E Q U E S T I O N N A I R E

BOP Retail

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For Floor Covering Stores:

1. Does the Insured sell Oriental/Persian Rugs? Yes No

For Home Furnishing Stores:

1. Does the Insured sell the following:

a. Oriental/Persian Rugs Yes No

b. Antiques Yes No

2. Does the Insured provide any installation or delivery service? Yes No

For Sports Apparel & Accessories Stores and Uniform Stores:

1. Does the Insured sell Protective Sports Equipment? Yes No

For Drug Stores:

1. Does the Insured sell or fill LPG tanks? Yes No

2. Does the Insured rent any equipment to others? Yes No

a. If Yes, please explain. _________________________________________________________________________________

3. Do the Insured’s liquor receipts exceed 35% of their total receipts? Yes No

4. Does the Insured offer check cashing for customers? Yes No

For China, Ceramic & Pottery stores and Art & Craft Supply stores:

1. Does the Insured fire ceramics? Yes No

For Collectibles Shops, and Book/Magazine Stores:

1. Does the Insured sell antiques? Yes No

113-1107 (7/14)

hanover.com

The Hanover Insurance Company | 440 Lincoln Street, Worcester, MA 01653

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